Resea ch A icle
How Public Heal h Nu ses Iden i y and In e ene in Child
Mal ea men Based on he Na ional Clinical Guideline
Paa ilainen Eija,1Helminen Mika,2Flinck Aune,3and Leh omäki Leila4
1School o Heal h Sciences (Nu sing Science), Uni e si y o Tampe e, E el¨
a-Pohjanmaa Hospi al Dis ic , Finland
2School o Heal h Sciences, Uni e si y o Tampe e and Science Cen e , Pi kanmaa Hospi al Dis ic , Finland
3School o Heal h Sciences, Uni e si y o Tampe e, Na ional Ins i u e o Heal h and Wel a e,
Technologies and P ac ices Assessmen Uni , FinSoc, Finland
4The Finnish Union o Public Heal h Nu ses, Finland
Co espondence should be add essed o Paa ilainen Eija; eija.paa ilainen@u a. i
Recei ed 1 Augus 2014; Accep ed 27 Oc obe 2014; Published 19 No embe 2014
Academic Edi o : Ka hleen Finlayson
Copy igh © 2014 Paa ilainen Eija e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License,
which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
Objec i es. To desc ibe how Finnish public heal h nu ses iden i y and in e ene in child mal ea men and how hey implemen
he Na ional Clinical Guideline in hei wo k. Design and Sample. C oss-sec ional su ey o 367 public heal h nu ses in Finland.
Measu es. A web-based ques ionnai e de eloped based on he con en a eas o he guideline: iden i ying, in e ening, and
implemen ing. Resul s. The esponden s epo ed hey iden i y child mal ea men mode a ely (mean 3.38), in e ene in i be e
(4.15), and implemen he guideline mode a ely (3.43, scale be ween 1 and 6). Those wi h expe ience o wo king wi h mal ea ed
child en epo ed hey iden i y hem be e (𝑃 < 0.001), in e ene be e (𝑃 < 0.001), and implemen he guideline be e
(𝑃 < 0.001) han hose wi h no expe ience. This di e ence was also ound o hose who we e awa e o he guideline, had
ead i , and pa icipa ed in aining on child mal ea men , as compa ed o hose who we e no awa e o he guideline, had no
ead i , o had no pa icipa ed in such aining. Conclusions. The public heal h nu ses wo ked qui e well wi h child en who had
expe ienced mal ea men and amilies. Howe e , he esul s poin ou se e al de elopmen al a ge s o inc easing aining on child
mal ea men , o de ising ecommenda ions o child mal ea men , and o applying hese ecommenda ions sys ema ically in
p ac ice.
1. Backg ound
Child mal ea men is a public heal h p oblem and a iola ion
o child en’s human igh s [1]. The la es esea ch in Finland
[2,3] shows ha child en and you h expe ience a wide ange
o mal ea men a home-meaning physical, emo ional, and
sexual iolence, neglec , and wi nessing iolence be ween
pa en s. The same o ms o child mal ea men a e obse ed
in o he coun ies in Eu ope and globally [4–8]. In addi ion,
esea ch a en ion has been paid o child en li ing in amilies
whe e in ima e pa ne iolence is pa o hei e e yday
li e [2,9]. Al hough much has been done o disco e ing
he si ua ion o child en li ing in iolen homes, e o
is s ill needed o knowing mo e abou iden i ica ion and
p e en ion p ac ices, o de eloping hem.
Resea che s in he child mal ea men ield show ha
child mal ea men wi hin he amily has an eno mous e ec
on child en and hei u u e physical, emo ional, and social
wel a e, o en esul ing in inequali y and ma ginaliza ion [10,
11]. A me a-analysis on he heal h consequences [12]s essed
ha all o ms o child mal ea men should be conside ed
impo an isks o heal h. Li elong impai men s in lea ning,
beha iou , and bo h physical and men al heal h a e s ongly
linked o ad e se expe iences in childhood. Exposu e o
child mal ea men can dis up no mal biological and social
de elopmen , c ea ing a cascade o e en s ha lead o oxic
s ess which esul s in changes in he de eloping ne ous,
ca dio ascula , immune, and me abolic sys ems which las
a li e ime [13]. Awa eness o he se ious long- e m con-
sequences should encou age be e iden i ica ion o hose
a isk and he de elopmen o e ec i e in e en ions o
p o ec child en om iolence [1,14]. In he UK, he Na ional
Ins i u e o Heal h and Clinical Excellence (NICE) guidance
Hindawi Publishing Co po a ion
Nu sing Resea ch and P ac ice
Volume 2014, A icle ID 425460, 7 pages
h p://dx.doi.o g/10.1155/2014/425460
2Nu sing Resea ch and P ac ice
was de eloped o aise heal hca e p o essionals’ awa eness o
he ale ing ea u es o child mal ea men [15]. In Finland a
guideline has also been w i en [10] conce ning iden i ying
andin e eninginchildmal ea men ,basedonasys ema ic
li e a u e e iew [16]. In he Finnish guideline, he isk
ac o s o he child, he pa en s, and he amily, signs
and symp oms, and he p inciples o iden i ying hem and
in e ening in child mal ea men a e desc ibed. The cen al
means o iden i ying and also in e ening in mal ea men
include, o example, knowing and e alua ing he signs o
mal ea men o a child, discussion wi h hei pa en s abou
he amily si ua ion and ela ionships wi hin he amily, and
discussion abou child ea ing p ac ices, home isi s, and
mul ip o essional p ac ices [10]. The guideline is mean o
be a ool o e idence-based p ac ice [17,18], used by public
heal h nu ses (PHNs) and in mul ip o essional collabo a-
ion wi h o he p o essionals mee ing and wo king wi h
child en, adolescen s, and amilies in di e en se ings. In
pape s e alua ing mul ip o essional p ac ices, he knowledge
exchange conce ning he si ua ion o he child and he amily
is equen ly ine ec i e o no amily o ien ed: p o essionals
may no ac i ely include he amily in he collabo a ion
o hey do no wo k in ensi ely enough oge he (e.g., see
[19,20]). Iden i ying and in e ening in amilies’ high- isk
si ua ions and child mal ea men is no as e idence-based as
i could be.
PHNs,asheal hca ewo ke swhomee almos allchil-
d en and hei amilies a clinics, schools, and homes, a e key
pe sons in iden i ying, p e en ing, and in e ening in child
mal ea men . In Finland PHNs p o ide ca e o child en
and amilies ac oss a wide age ange, om ma e ni y ca e
and p eschool o school-aged child en, and in many di e en
se ings including clinics, clien s’ homes, and schools. Be o e
school age (age 7 in Finland), child en and hei amilies
isi child heal h clinics a leas 16 imes and, once in school,
child en and young people will see a PHN a leas once a yea .
These se ices a e ee o all amilies and almos all amilies
use hem [21].
The objec i e o he cu en esea ch was o desc ibe how
Finnish PHNs iden i y and in e ene in child mal ea men
and how hey implemen he clinical guideline conce ning
hese issues in hei wo k. Findings can be used o he
de elopmen o iden i ica ion and in e en ion p ac ices and
educa ion.
2. Resea ch Ques ions
This s udy was designed o add ess he ollowing esea ch
ques ions.
(1) How do PHNs iden i y child mal ea men ?
(2) How do hey in e ene in child mal ea men ?
(3) How do hey desc ibe hei implemen a ion possibil-
i ies conce ning iden i ying and in e ening in child
mal ea men ?
(4) Wha a e he backg ound ac o s ha p omo e iden-
i ica ion, in e en ion, and implemen a ion?
3. Me hods
3.1. Design and Sample. The esponden s o he cu en
su ey we e ec ui ed om he egis e o he Finnish Union
o Public Heal h Nu ses, in 2012. All he membe s who
had an email add ess and appea ed o ha e wo ked in
child- ela ed clinics (𝑛 = 800) we e sen he elec onic
ques ionnai e in Feb ua y 2012 and we e eminded a e wo
weeks. The boa d o he union ga e he e hical app o al
and esea ch pe mission. Comple ing he su ey indica ed
in o med consen and no iden i ie s we e collec ed [22]. In
he le e a ached o he ques ionnai e, i was s a ed ha
he pe mission o he esea ch was clea , he esul s will be
published anonymously and illing in he ques ionnai e was
in e p e ed as pa icipa ion in he s udy. Al oge he 367
PHNs answe ed he su ey, esul ing in he esponse a e o
46%.
3.2. Measu es. The su ey ins umen was de eloped o his
s udy, and i s con en was based on he Na ional Clinical
Guideline conce ning iden i ying and in e ening in child
mal ea men and implemen ing he guidelines on his opic
[10,16]. I included i e backg ound ques ions (gende ,
age, wo k expe ience, p esen job and loca ion, and wo k
expe ience in ci ies/coun yside/bo h) and h ee ques ions
conce ning whe he hey knew ha guidelines exis ed and,
i so, whe he hey had ead hem and whe he hey had
been ained on he opic. They we e also asked how many
child mal ea men cases hey had encoun e ed o suspec ed,
du ing he p e ious six mon hs. The su ey ins umen con-
sis ed in Like Scale s a emen s (6 = o ally ag ee, 1 = o ally
disag ee) di ided unde h ee sum a iables: iden i ying (8
s a emen s), in e ening (31 s a emen s), and implemen ing (8
s a emen s). The ins umen was de eloped by he g oup o
esea che s (𝑛=12) who we e expe s in child mal ea men
issues and/o s a is ical me hods. The ins umen was pilo
es ed by sending he elec onic e sion o en PHNs who
comple ed he ques ionnai e. Modi ica ions we e made based
on hei esponses.
3.3. Da a Analysis. The means and s anda d de ia ions (SDs)
o pe cen age dis ibu ions we e calcula ed o all demo-
g aphic a iables. Responses o nu ses’ pe cep ions o how
hey iden i y and in e ene in child mal ea men and how
hey implemen he guidelines we e di ided in o g oups:
disag ee ( esponses o 1–3) and ag ee ( esponses 4–6). These
h ee a iables we e also combined as sum a iables, iden-
i ying (C onbach’s Alpha 0.866), in e ening (0.957), and
implemen ing (0.854), showing solid eliabili y [23]. Di e -
ences be ween g oups acco ding o demog aphics we e es ed
using Pea son co ela ions, 𝑡- es s, and ANOVA. Linea
eg ession analysis was also done o see which ac o s explain
iden i ying, in e ening, and implemen ing.Ha ingwo keda
ma e ni y and amily planning, child heal h clinic, school
heal h, and all o he places we e used as sepa a e independen
bina y a iables in he model, oge he wi h suspicion o
mal ea men (o ac ual mee ing o mal ea ed child en) and
wo king yea s.
Nu sing Resea ch and P ac ice 3
Table 1: Backg ound in o ma ion conce ning he pa icipan s (𝑁 = 367).
Va iables Mean (SD)
Age in yea s 42,5 (10,8)
Wo king yea s as a nu se 12,3 (9,9)
Pe cen ages
Wo king in u ban a eas/coun yside/bo h 65,9/26,7/7,4
Knowledge o he exis ence o a guideline (yes/no)? 77,1/22,9
Had hey ead he guideline (yes/no)? 46,3/53,7
Had hey had educa ion on he opic (wi hin a yea /ea lie /ne e )? 11,2/34,6/54,2
How many (0/1–4/5 o mo e//missing) child mal ea men cases hey had me du ing six mon hs? 36,8/19,9/4,6//38,7
How many (0/1–4/5 o mo e//missing) suspec ed child mal ea men cases hey had me du ing six mon hs? 28,3/35,7/6,5//29,4
4. Resul s
4.1. Demog aphic Cha ac e is ics. Almos all o he espon-
den s (𝑁 = 367) we e women ( he e we e only wo men),
wi h a mean age o 42 ( anging om 23 o 64) and a mean
wo king ca ee o 12 yea s ( anging om 0 o 37 yea s).
Thi yeigh pe cen o hemwo kedin amilyplanningand
ma e ni y, 45% in a child wel a e clinic, 30% in school heal h,
and48%ino he clinics, o ins anceins uden heal hca e
clinics o clinics o adul s. The esponden s may wo k in
se e al clinics; o ins ance 107 esponden s wo ked in bo h
ma e ni y and child wel a e clinics. Se en y-se en pe cen
knew ha he e was a guideline, 46% epo ed hey had ead
i , and 46% had pa icipa ed in aining on he opic. Du ing
he p e ious six mon hs, 37% o he esponden s epo ed
hey had no me mal ea ed child en, 20% had me 1–4
mal ea ed child en, and 5% had me i e o mo e mal ea ed
child en, o he bes o hei knowledge. Co espondingly,
28% epo ed hey had no suspec ed any mal ea men cases,
36% had suspec ed ha 1–4 child en hey encoun e ed had
been mal ea ed, and 7% had suspec ed ha i e o mo e
child en had been mal ea ed (Table 1).
4.2. Iden i ying Child Mal ea men . The PHNs ag eed hey
we e able o iden i y mal ea ed child en mode a ely well
(mean 3.38, SD 0.84). Only 43% ag eed he child’s beha iou
was a ac o in iden i ying child mal ea men , and 37%
ag eed ha he pa en s’ beha iou was a ac o . Fi y- ou
pe cen ag eed ha physical signs we e a ac o and 44%
ag eed ha psychological signs we e a ac o . Only 15% o he
PHNs mee mal ea ed child en o en, acco ding o hei own
e alua ion (Table 2).
4.3. In e ening in Child Mal ea men . In e ening in child
mal ea men was easie o he esponden s (mean 4.15, SD
0.91) han iden i ying i (mean 3.38). Mos (80%) esponden s
el hey discussed e e yday p oblems and p oblems in he
child’s de elopmen adequa ely (80%) and ha hey ad ised
he pa en s o seek help when hey need i (88%). On he o he
hand, he esponden s epo ed ha couple’s ela ionship
p oblems a e discussed less o en (52%). The esponden s
hough hey helped he mal ea ed child (52%) and he
amily (50%) su icien ly well. Fi y-nine pe cen hough ha
mul ip o essional collabo a ion was wo king well in hei
Table 2: I ems included in iden i ying sum a iable and he
pe cen ages ha ag ee/disag ee (𝑁 = 367).
Iden i ying (ag ee 4–6/disag ee
1–3)
PHNs mee mal ea ed child en o en 15/85%
PHNs ecognize child mal ea men based on
Child- ela ed isk ac o s 53/47%
Risk ac o s ela ed o pa en s 66/34%
Family- ela ed isk ac o s 67/33%
The child’s beha io 43/57%
The pa en s’ beha io 37/63%
PHNs ecognize physical signs su icien ly well 54/46%
PHN’s ecognize men al signs su icien ly well 44/56%
municipali y,and50%o hem ecei eenoughsuppo o
mul ip o essional collabo a ion om hei supe io s. Fi y-
ou pe cen o he esponden s ha e join guidelines o child
mal ea men cases, and 65% ha e clea ins uc ions on how
o make a epo o child p o ec ion au ho i ies (Table 3).
4.4. Implemen ing he Clinical Guideline. PHNs epo ed hey
implemen ed he ecommenda ions w i en in he guideline
mode a ely (mean 3.43, SD 1.01). Among he esponden s,
87% conside ed he guidelines impo an . The guideline o
child mal ea men guides he wo k o 57% o he espon-
den s, and 87% epo ed hey will gladly adjus hei wo k
p ac ices acco ding o he guideline. O he esponden s, 21%
had ecei ed enough aining ega ding he guideline and
44% had s udied he con en o he guideline independen ly.
Twen y- h ee pe cen o he esponden s had discussed he
guideline a hei wo kplace, 44% suppo ed each o he in
ac ions ollowing he guideline, and 38% hough ha hei
wo kplace had su icien esou ces o ac ing acco ding o he
guideline.
4.5. Fac o s P omo ing Iden i ying, In e ening, and Imple-
men ing. PHNs who had me mal ea ed child en epo ed
hey we e able o iden i y child mal ea men be e han
hose wi hou ha expe ience, acco ding o hei own e alua-
ion (mean 3.79 e sus 3.07, 𝑃 < 0.001). They also in e ened
in child mal ea men cases be e (mean 4.48 e sus 3.88,
4Nu sing Resea ch and P ac ice
Table 3: I ems included in in e ening sum a iable and he pe cen ages ha ag ee/disag ee (𝑁 = 367).
In e ening (ag ee 4–6/disag ee 1–3)
PHNs discuss su icien ly well wi h amilies abou
Risk ac o s in amilies 61/39%
Child ea ing p ac ices 69/31%
P oblems in he couple’s ela ionship 52/48%
P oblems in e e yday li e 80/20%
Child de elopmen 80/20%
P oblems in child de elopmen 79/21%
PHNs ad ice pa en s su icien ly well o
Seek help when needed 88/12%
Ac well in si ua ions when he child has a an um 76/24%
Ac well when he child beha es badly 71/29%
Ac well when he child does no ul ill expec a ions 60/40%
Ac wellwhen hechildhasspecialneedso isill 69/31%
Ac well when he child c ies 76/24%
Discuss hei join child ea ing p ac ices 67/33%
When suspec ing child mal ea men , PHN
Asksabou i s aigh o wa dly 69/31%
Always makes a child wel a e no i ica ion 86/14%
Helps he mal ea ed child su icien ly well 52/48%
Helps he amily su icien ly well 50/50%
Documen s mal ea men su icien ly well 82/18%
Guides o ollow-up ea men su icien ly well 81/19%
Lis ens o he amily unde suspicion su icien ly well 83/17%
Collabo a es su icien ly well wi h o he p o essionals 86/14%
Thinks mul ip o essional collabo a ion wo ks well in he municipali y 59/41%
Thinks mul ip o essional collabo a ion wo ks well in hei o ganiza ion 69/31%
Knows who o con ac when suspec ing child mal ea men 87/13%
When suspec ing child mal ea men PHN ge s enough suppo om
Supe io s 50/50%
Pee s 82/18%
The clinic physician 69/31%
Child p o ec ion 69/31%
In ou clinic:
We ha e join ins uc ions o handle child mal ea men cases 54/46%
We ha e clea ins uc ions on how o make a child wel a e no i ica ion 65/35%
I is possible o wo k acco ding o he child mal ea men guideline 59/41%
𝑃 < 0.001) and implemen ed he ecommenda ions o he
guideline be e (mean 3.79 e sus 3.16, 𝑃 < 0.001). The same
applied onu seswhowe eawa eo heguideline,had eadi ,
and pa icipa ed in aining on ecognizing and in e ening
in child mal ea men (Table 4).
Acco ding o he eg ession analysis, wi h wo king yea s
and suspicion o mal ea men as addi ional independen
a iables, hose wo king as school heal h nu ses we e able
o iden i y cases be e han o he s. In addi ion, hose
wo king as school heal h nu ses o a child wel a e clinics
also in e ened be e han o he s. Those wo king a amily
planning o ma e ni y clinics implemen ed he guideline
be e han o he s. Those who had suspec ed child mal ea -
men ob iously had be e iden i ica ion, in e en ion, and
implemen a ion han hose who had no suspec ed child
mal ea men (Table 5).
Acco ding o he eg ession analysis, wi h wo king yea s
and ac ual con ac wi h mal ea ed child en as addi ional
independen a iables, only in e en ion was a a highe le el
( o hose who wo ked as school heal h nu ses) compa ed o
o he s. Those who had me mal ea ed child en ob iously had
be e iden i ica ion, in e en ion, and implemen a ion han
hose who had no me mal ea ed child en.
5. Discussion
The PHNs iden i ied child mal ea men o a mode a e
deg ee. They hough ha hey iden i ied isk ac o s ela ed
Nu sing Resea ch and P ac ice 5
Table 4: The e ec s o sepa a e backg ound ac o s on iden i ying, in e ening,andimplemen ing.
Va iables Iden i ying In e ening Implemen ing
Age (co ela ion, signi icance) 0,01 NS 0,01 NS 0,14∗∗
Wo king yea s as a nu se (co ela ion, signi icance) −0,02 NS −0,03 NS 0,07 NS
Wo king in u ban a eas/coun yside/bo h (ANOVA sig.) NS NS NS
Knowledge o he exis ence o a guideline (𝑡- es sig.) ∗∗∗ ∗∗∗ ∗∗∗
PHN had ead he guideline (𝑡- es sig.) ∗∗∗ ∗∗∗ ∗∗∗
PHN had had educa ion on he opic (ANOVA sig.) ∗∗∗∗∗∗∗
How many (0, 1−4, 5, o mo e) child mal ea men cases hey had me du ing six
mon hs (ANOVA sig.) ∗∗∗ ∗∗∗ ∗∗∗
How many (0, 1–4, 5 o mo e) suspec ed child mal ea men cases hey had me
du ing six mon hs (ANOVA sig.) ∗∗∗ ∗∗∗ ∗∗∗
Es ima e signi icance (𝑃 alue): NS = no signi ican ; ∗<0,05; ∗∗ <0,01; ∗∗∗ <0,001.
Table 5: Es ima ed uns anda dized eg ession coe icien s o all a iables om linea eg ession models, sepa a ely o iden i ying,
in e ening,andimplemen ing (𝑁 = 367).
Model a iables Iden i ying In e ening Implemen ing
Ha e wo ked in: ma e ni y and amily planning 0,075 0,127 0,296
Ha e wo ked a : a Child Heal h Clinic −0,103 0,325 0,309
Ha e wo ked a : a School Heal h Clinic 0,216 0,301∗0,133
Ha e wo ked a : o he places 0,086 −0,381∗0,044
Wo king yea s 0,000 −0,003 0,012
Had me mal ea men cases (yes/no) 0,658∗∗∗ 0,390∗∗ 0,583∗∗∗
Ha e wo ked in: ma e ni y and amily planning −0,058 0,227 0,344∗
Ha e wo ked a : a Child Heal h Clinic −0,008 0,309∗0,096
Ha e wo ked a : a School Heal h Clinic 0,293∗0,316∗∗ 0,068
Ha e wo ked a : o he places −0,038 −0,317∗∗ −0,106
Wo king yea s −0,005 0,000 0,015∗
Had suspec ed mal ea men cases (yes/no) 0,507∗∗∗ 0,322∗∗ 0,310∗
Es ima e signi icance (𝑃 alue): ∗<0,05; ∗∗ <0,01; ∗∗∗ <0,001.
o hechild,pa en s,o he amily hebes andissues ela ed
o he child’s o he pa en s’ beha io he wo s . They iden-
i ied signs o physical and emo ional abuse be e . Simila
esul sha ealsobeen epo edinasu ey o hospi als a
[24]. Di e en o ms o child mal ea men a e iden i ied
a di e en le els: signs o physical mal ea men a e o en
clea e han, o example, signs o emo ional mal ea men o
neglec .
The esponden s hough ha hey can in e ene in mal-
ea men be e han hey can iden i y i . They discussed bo h
e e yday issues and p oblems ela ed o child de elopmen
wi h he pa en s a a child heal h cen e , bu hey ailed o
discuss ela ionship issues su icien ly. These esul s also ag ee
wi h ea lie esul s [9,25–27].
When suspec ing ha a child has been mal ea ed, he
esponden s asked abou i di ec ly, made a child p o ec ion
epo , and documen ed he e en in he child’s documen-
a ion. In hei opinion, howe e , hey el ha hey we e
no able o p o ide enough help o he child and he amily
in he si ua ion. Acco ding o ou eg ession models, hose
nu ses wo king a schools assessed hei child mal ea men
iden i ica ion p ac ices mo e posi i ely han hose wo king
a o he places. This may be because child en’s beha io
o p oblems in school a endance may mo e likely lead o
discussions abou he child’s si ua ion han a a child wel a e
clinic. A clinic child en a e younge and do no exp ess
being ill so clea ly. A amily planning o ma e ni y clinics
nu ses implemen ed he guideline e y well a a knowledge
le el and we e willing o use his knowledge. Howe e , a
he iden i ying and in e ening le els, hey we e no able o
apply hei willingness in eal si ua ions. Acco ding o ea lie
s udies [9,25,27], PHNs eel ha hey a e in a good posi ion
o ake he ac ions needed bu hey need mo e aining on
applying hei knowledge in eal si ua ions when wo king
wi h child en and amilies.
Acco ding o he PHNs, mul ip o essional collabo a ion
is no wo king e y well in he municipali y o o ganiza ion
whe e hey wo k. Common guidelines on how o ac on
child mal ea men suspicions o how o make a child
p o ec ion epo we e no used o en enough. Some o he
esul s may seem o be con using, o example, conce ning
ag eeing on he impo ance o he guidelines e en when no
knowing hem e ywell.Thismaybedue o he ac ha
he esponden s ag ee ha iden i ica ion and in e ening a e
impo an bu hey do no know well enough wha o do and
how o implemen hei knowledge in o mul ip o essional

6Nu sing Resea ch and P ac ice
wo k. Acco ding o Leh om¨
aki [17], he a i udes owa ds ca e
guidelines in gene al a e posi i e bu applying hem equi es
suppo and adminis a i e e o om hei supe io s and
de elopmen o join p ac ices. In his s udy, he esponden s
a ed hemsel esasno ecei ingenoughsuppo om hei
supe io s o child p o ec ion au ho i ies. Acco ding also
o Yagasaki and Koma su [28], guidelines a e ega ded as
impo an ; howe e hey a e no ully applied in o p ac ice.
To be success ul in applying any esea ch-based guidelines,
o ganiza ional, adminis a ional, mul idisciplina y, and indi-
idual ba ie s ha e o be challenged by a s a egy ha gi es
ools o e ec i e implemen a ion.
PHNswhohadme mal ea edchild eno whohad
pa icipa ed in aining on child mal ea men we e able
o iden i y mal ea men and hey in e ened in i be e
han hose who had no me such child en o pa icipa ed
in such aining. Ea lie s udies ha e also gained simila
esul s. Acco ding o Paa ilainen e al. [24], nu ses who ha e
pa icipa ed in aining o who ha e me mal ea ed child en
ind iden i ica ion and in e en ion e en mo e di icul han
nu ses who ha e no encoun e ed hese issues a all. Based
on his,i ispossible ha nu seswhoha eexplo ed heissue
and ac ed on i ha e a mo e p o ound unde s anding o how
di icul andcomplex heissueis.Also,whenaskingabou
hese di icul issues wi h a c oss-sec ional design as we did
in ou s udy, using a sel - epo ed ques ionnai e migh also
be a limi a ion. Howe e , i seems ha PHNs did no o e
es ima e hei capabili y in iden i ying o in e ening and
many de elopmen al challenges can be p esen ed based on
he esul s.
5.1. Implica ions o Nu sing P ac ice. PHNs a e gene ally
awa e ha iden i ica ion o and in e en ion in child mal-
ea men a e an impo an pa o hei job (see also [25]).
Howe e , he lack o e o in c ea ing common guidelines
and p ac ices and ensu ing he unc ionali y o mul ip o es-
sional collabo a ion we e weaknesses in p ac ical wo k and
ac ions [19]. This is a ques ion o wo k o ganiza ion and
managemen andalsoo ocusingonac i i ies ha a e eally
help ul and e ec i e o child en and amilies. PHNs a e in a
posi ion o ake a leade ship ole in he p e en ion o child
mal ea men as well as add essing he sys em ba ie s such
as knowledge exchange challenges o coo dina ion wi hin
mul ip o essional ac i i ies. This will lead o suppo ing
amilies be o e isks o mal ea men a e ealized in o ac ual
mal ea men in amilies. Sol ing o ea ing child mal ea -
men casesis he esponsibili yo manyadminis a i ely
sepa a e uni s: child heal h cen e s, hospi als, a day ca e,
and in child p o ec ion. The manage s o hese uni s should
ensu e ha collabo a ion, in bo h p e en ion and ea men
le els, can wo k ac oss adminis a i e bounda ies. This kind
o de elopmen can be done globally, based on in e na ional
esea ch e idence and on he se ice sys em o child en and
amilies in each coun y.
5.2. Implica ions o Nu sing Educa ion. Mo e a en ion
should be paid o aining on child mal ea men in he
basic and complemen a y educa ion o PHNs. This aining
should include he opics o high isk amily en i onmen s
(iden i ying and discussing hem), discussing he e e yday
issues and p oblems o amilies, he isks and mani es a ions
o mal ea men , he iden i ying symp oms and signs, and
he conc e e means and me hods o iden i y and in e ene
in mal ea men . The e should also be aining on issues
ega ding mul ip o essional collabo a ion and legisla ion.
The se ice sys em and legisla ion conce ning child en and
amilies di e in each coun y; his has o cou se o be
conside ed. Howe e , he heal h, well-being, and needs o
child en a e global issues and can be used as he basis o
educa ion.
5.3. Implica ions o Nu sing Resea ch. These esul s show
well he si ua ion conce ning he iden i ica ion o and in e -
en ion in child mal ea men by PHNs and how hey imple-
men he guideline conce ning hese issues in hei wo k
wi h child en and amilies. Fu he knowledge is needed, o
example, on how o p o ide educa ion on hese issues and
change PHNs’ p ac ices. This could be done by a ollow-
up s udy wi h an educa ional in e en ion. Also, compa-
able da a om o he coun ies would be in e es ing and
impo an , p o iding knowledge o he si ua ion in di e en
coun ies. This s udy is al eady in p ocess, and he e is al eady
da a om Japan collec ed wi h he same ins umen .
6. Conclusion
The p ima y p e en ion o child mal ea men is he mos
impo an issue om he pe spec i es o child en, amilies,
and hewholesocie y,inFinlandandglobally,al hough
also seconda y and e ia y p e en ion a e e y c ucial
o de elopmen . In aiming o p e en child mal ea men
and inc ease he well-being o child en, guidelines and isk
assessmen p ac ices o PHNs and suppo i e in e en ions
o amilies wi h child mal ea men isk should be de eloped
ande alua ed.Thiscanbedonebyusingguidelines o
c ea ing e ec i e in e en ions and e alua ing he p ocess
andou comesby ollowup esea ch.
Con lic o In e es s
The e is no con lic o in e es s.
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